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Calf / lower leg · Mid-Portion Achilles Tendinopathy

Mid-Portion Achilles Tendinopathy

Your Achilles, the thick tendon behind your ankle, is irritated and overloaded a few centimetres above your heel. Rebuilding tendon capacity helps.

The tendon got loaded faster than it was conditioned for, whether a jump in running/walking/hills, new shoes, or returning to sport too quickly. Build strength with progressive loading (not rest): a calmer isometric start, then heavy slow strengthening and eccentric heel drops over about 12 weeks.

How it typically shows up

Gradual-onset pain and stiffness in the Achilles cord 2-6cm above the heel, worst for the first steps in the morning and with loading, rather than pain in the calf muscle or directly at the heel-bone attachment. This mid-portion tendon load problem responds to progressive loading.

How long recovery takes

Daily pain often improves around 12 weeks with slow, strong calf work. Running takes longer, requiring spring and run-walk tolerance.

The phased recovery approach

  1. Phase 1 · 1–3 weeks

    Calm

    Settle tendon irritation before loading.

    What you get back: calmer, looser mornings.

    • Ankle Circles: 1–2 sets × 10–12 reps · Keep it smooth and pain-free. This is a gentle mobility warm-up, not a stretch to force. · Sit or lie down with your leg supported.
    • Ankle Pumps: 1–2 sets × 10–12 reps · Move gently to maintain ankle mobility and ease stiffness. · Point your foot down and away.
    • Isometric Calf Hold: 2–4 sets × 30–45s hold · Hold steadily, easing tendon pain without provoking it. · Rise to comfortable mid-range on both feet or the sore one.
    • Isometric Calf Push: 2–4 sets × 30–45s hold · Hold gently, steadily and pain-free, without hard pushing. · Sit with your foot flat on the floor or against a wall.

  2. Phase 2 · 6–12 weeks

    Rebuild

    Load heavier and slower to rebuild tendon strength over weeks.

    What you get back: a strong, loaded calf raise.

    • Loaded Bent-Knee Eccentric Heel Drop: 3–4 sets × 15 reps · Bend knees to target soleus, adding weight once sets stop feeling hard. · Hold a dumbbell in one hand and a wall or rail with the other for balance, or use a loaded calf machine.
    • Bent-Knee Eccentric Heel Drop: 3–4 sets × 15 reps · Bent knees target soleus. Work the slow lowering. Add backpack weight only once current loads feel comfortable, within the pain rule. · Hold a wall or rail for balance.
    • Ankle Circles: 1–2 sets × 10 reps · Keep it smooth and pain-free. This is a gentle mobility warm-up, not a stretch to force. · Sit or lie down with your leg supported.
    • Ankle Pumps: 1–2 sets × 10 reps · Move gently to maintain ankle mobility and ease stiffness. · Point your foot down and away.

  3. Phase 3 · 1–12 weeks

    Your path from here

    This part depends on your goal. Your program follows one of these.

    • Running again

      4–12 weeks for this path

      1. Running

        4–12 weeks

        Rebuild tendon spring for running and jumping without flares.

        What you get back: running and jumping.

        • Run-Walk Intervals: 1 set × 10–30 min of activity · Stop intervals if tendon symptoms change stride. · Jog the shown interval easily.
        • Ankle Circles: 1–2 sets × 10 reps · Keep it smooth and pain-free. This is a gentle mobility warm-up, not a stretch to force. · Sit or lie down with your leg supported.
        • Ankle Pumps: 1–2 sets × 10 reps · Move gently to maintain ankle mobility and ease stiffness. · Point your foot down and away.
        • Loaded Bent-Knee Eccentric Heel Drop: 4–5 sets × 12–15 reps · Bend knees to target soleus, adding weight once sets stop feeling hard. · Hold a dumbbell in one hand and a wall or rail with the other for balance, or use a loaded calf machine.

    • Gym training

      2–6 weeks for this path

      1. Gym

        2–6 weeks

        Restore full gym tendon strength before adding impact.

        What you get back: loaded calf training again.

        • Machine / Leg-Press Calf Raise: 3–4 sets × 6–15 reps · Use heavy, slow resistance, about 3 seconds up and 3 seconds down, with a load you can just finish for the prescribed reps. Rest 2-3 minutes between sets. · Set up on a leg-press sled or standing calf machine.
        • Loaded Calf Raise: 3–4 sets × 6–15 reps · Move slowly both ways, about three seconds up and three seconds down, and lower only back to floor level rather than below it. Rest 2-3 minutes between sets. · Hold weight or use a calf machine, heels initially at floor level.
        • Backpack Bent-Knee Calf Raise: 3–4 sets × 6–15 reps · Keep working knee softly bent, rising and lowering 3 seconds each, adding backpack weight once sets stop feeling hard. · Wear a backpack loaded with books, standing on your working foot, fingertip on a wall for balance.
        • Single-Leg Heel Raise: 3–4 sets × 6–15 reps · Slow up and slow down. Aim for the same quality on this side as the good one. Building to 20-25 controlled raises on the sore leg is the marker that it is ready for heavier work. · Rest a fingertip on a wall for balance.

    • Just everyday life, pain-free

      1–3 weeks for this path

      1. Daily life

        1–3 weeks

        Keep loading the tendon so standing, stairs, and walking stay pain-free.

        What you get back: standing, stairs, and walking.

        • Graded Walking: 1 set × 25–30 min of activity · Keep the pace easy at first. · Walk on flat, predictable ground at an easy pace.
        • Ankle Circles: 1–2 sets × 10 reps · Keep it smooth and pain-free. This is a gentle mobility warm-up, not a stretch to force. · Sit or lie down with your leg supported.
        • Ankle Pumps: 1–2 sets × 10 reps · Move gently to maintain ankle mobility and ease stiffness. · Point your foot down and away.
        • Gastrocnemius Stretch: 3 sets × 30s hold · Keep the stretch gentle and pain-free, never forced. · Lean on a wall, injured leg back, heel flat on the floor.

Exact exercises, sets and progression depend on your severity, equipment and goal. This is the shape of the program, not a one-size prescription.

What matters while you recover

  • How much pain is okay (the tendon rule)

    Moderate pain while loading is usually fine if it settles by next morning. Ease the load if it lingers or worsens week to week. Build strength, not just rest.

  • Earn the deeper heel drop

    The sore spot sits a few centimeters above the heel. Do floor-level heel raises while sore, add heel drops off a step later. Heel-bone pain is a different, shorter plan.

  • Slow but reliable

    Tendons respond well to loading but recover slowly, so give it around 12 weeks of steady work. Morning stiffness easing is a good early sign.

Common questions

Should I rest it until it stops hurting?
No. Tendons need load to recover. Resting tends to make them weaker and more sensitive. The plan loads it progressively within a pain rule, rather than waiting for the pain to vanish first.
How much pain is okay during the exercises?
Moderate pain is fine while you load, straight afterwards, and the next morning. The rule that really governs progress is the last one: pain and stiffness must not increase from week to week. If they climb, ease the load.
Where should this pain sit?
The tenderest spot should be in the Achilles cord a few centimetres above the heel. Pain directly where the tendon meets the heel bone is a different pattern with its own shorter-range loading plan.

Go deeper

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